Hacker News Reader

Comment by deng | Hacker News Reader

"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potentially life-saving) treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission. [...] there was only limited public outcry in Sweden when this came out, the common narrative being that those in care homes are expected to die soon anyway. [...] Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives."

This is quite shocking. I didn't think this would be possible in a country like Sweden.

View on HN

In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark.

This is why Sweden has had a such a high death toll, because of bad care given to the elderly.

One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy.

And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying.

Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically.

I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state.

Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back".

This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.

This is not Sweden. While a lot of it rings true; like the strange mix of fierce indivudalism and collectivism in Sweden, and how we really did mess upp early elder care. I only have anecdata about elder care; my relative just now died in an one such home from brain damage + malnutrition the amount of care, happines and grit that was done to make her eat was heart warming. The same place hade been hit very hard by Covid, which ment they now had extreme proceedures in place that limited our visiting possibilities, that ment they had zero Covid cases during the peaks in 2021.

I think most of the care homes learnt after the first wave, at least I hope that my experience was representive.

While your personal experience is heartwarming, others here point to what I would describe state-approved cruelty of effectively euthanizing elderly who got seriously sick with covid earlier. That's not cool at all and even if now things are different its a right thing to point to these widespread failures that caused a lot of unnecessary death.

Few elderly patients who end up on ventilators for COVID survive, plus the process is very painful and causes permanent damage if you survive. So morphine actually sounds like a pretty good way to go, assuming there's some form of informed consent.

The problem was that there were cases were consent was not given and of healthy 70 year olds having to fight for ventilators at least in the beginning. From what I understood a lot changed when people realized what was happening in June 2020, the paper is pretty vague about this it talks mainly about the first half of 2020.

That is a pretty extreme interpretation of the paper. That view is also not helpfull if you want to talk about the regional problems around Sweden, it has been mentioned in other comments here. The paper is just bringing up a discussion we have had since june 2020 in Sweden, I sure do not think we will not stop discussing it.

> state-approved cruelty of effectively euthanizing elderly

Unless I got the discussion completely backwards, the point here was that these homes are not run by the state. They are either private or by small municipalities, and are not really intended to provide medical care in the same way as hospitals do.

There are probably a lot of details here that's not at all obvious to an outsider of the system, exactly how the care is organized, paid for, and what medical facilities they can access, but I hope that they can learn and improve from this so the next pandemic do not hit the elderly quite this bad.

That some other countries may or may not have been hit worse does not make it any better. This is not a competition.

I would argue that Sweden is not collectivistic at all.

In the golden years of the Folkhem (the people's home) Sweden was collectivistic to a larger extent, but because of the massive increase of living standards, a huge middle class emerged.

Core beliefs of the middle class is typically high individualism and materialism which usually translates to some form of liberalism.

Many, especially on the right, makes the mistake to equate high taxes with collectivism, but that is not necessarily the case, because it depends on how the taxes are collected and what the taxes are used for.

Today the Swedish's left argument for high taxes is to increase individual freedom, not collective freedom. The Swedish's right argument for low taxes is to increase individual freedom, not collective freedom, thus both the left and the right in Sweden is ruled by the same middle class and every big topic in Sweden since the at least 20 years has been of a middle class perspective.

Reducing society to high vs low taxes is one of the most extreme forms of individualism you can have.

> I would also argue that it culturally exists ageism in Sweden

In the supplements, they cite from "LARSSON, S.-O. & HARTIG, M. 2015. Ålderism (Ageism). In: (UPS), U. P. S. (ed.)":

"Sweden also ranks globally among the countries with the lowest regard to the elderly based on pre-pandemic surveys. Ageism, defined as prejudices or stereotypical perceptions based on a person's age and which can lead to discrimination, is a bigger problem in Sweden than in the other Nordic countries. When Swedish people are asked to rank the social position of different age groups in their country, the position of the elderly (70+ years) is ranked as the second lowest in the world. The elderly are also considered to have a much weaker position in society than young adults. This may be a consequence of prevailing individualism and rapid digitalisation and technological development, and weaker ties between the different generations (the family is not at the centre as in several other countries). In the Swedish society, aging is mainly regarded as a biological process of decay or decline, dehumanising the senior in the eyes of the rest of society, leading to marginalization and discrimination; considering the senior as a passive object."

One thing that I did not hear much of during the pandemic were the actual opinions of the elderly on the subject. Did they really want all of the measures that were taken?

Sweden didn't have a high death toll. On a per capita basis they're lower than many other comparable EU countries such as France.

https://www.worldometers.info/coronavirus/#countries

Right, but it's only barely lower than France, about half-way between Germany and France. And then there's the question whether France is a great comparison; if you compare Sweden to its closer neighbors Finland and Norway - it's much, much worse off; and even compared to the more densely populated Denmark it's almost twice as bad. At best, the numbers look mediocre for Sweden - and that's if you somehow make the case it's more comparable to France+Germany than, say, Norway or Denmark. But if you consider other Nordic countries as baselines, the results look terrible.

Put it this way: imagine somebody gave you the data for deaths for many of the nearby countries, and lots of information about them all; vaccination rates, age distributions etc. The only number missing is Sweden's death rate. Would you have guessed it correctly? or guessed higher? or lower? I definitely would have guesses lower, somewhere between 2 to three times too low. Frankly, even with knowledge that their lockdowns were lax I would not have expected this high a death rate; after all it's not like it was business as usual or anything - people were socially distancing.

I'd say comparing countries like this is fraught, but also that Sweden has an unexpectedly high death toll. Whether it's high in absolute numbers, and what exactly the cause is... who knows. The cause may well be largely unrelated to their policies; clearly the differences between countries in general are not at all easily explained by policy differences, after all. But I don't agree with your statement that it outright doesn't have a high death toll.

"Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives."

This is from the abstract, but as far as I could find, this is never mentioned in the actual text of the paper? Certainly there's no reference to "oxygen", "morphine", or "administer" on the linked web page. So I guessed this had something to do with "end-of-life care", which is discussed in Supplement 6. But I could not find any explicit reference to morphine or oxygen there or in the sources of the supplement, either.

Maybe it's in (Habib, 2020), but the link is broken.

> Maybe it's in (Habib, 2020), but the link is broken.

It's easy to find the article, you just google search with the article title.

https://www.bmj.com/content/369/bmj.m2376

> Yngve Gustafsson, professor of geriatric medicine at Umea University, noted that the proportion of older people in respiratory care nationally was lower than at the same time a year ago, despite people over 70 being the worst affected by covid-19. He expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes.

> “Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” he told the Svenska Dagbladet newspaper [5], “It’s active euthanasia, to say the least.”

Thanks!

Is murder, not euthanasia.

Euthanasia requires the explicit desire of being killed, clearly expressed by the patient, normally with the family knowledge and after legal consultation that proves that there is excruciating pain are there is not a better alternative for treatment.

And this is killing a helpless person unable to defend his life or will, and blocking their relatives to help him/her in this task. And it was not exclusive from Sweden, probably.

Not a paper, but still:

https://www.science.org/content/article/it-s-been-so-so-surr...

"A 17 March directive to Stockholm area hospitals stated patients older than 80 or with a body mass index above 40 should not be admitted to intensive care, because they were less likely to recover. Most nursing homes were not equipped to administer oxygen, so many residents instead received morphine to alleviate their suffering."

From the perspective of someone living in Sweden: considering how the elderly care sector seems to be organised to extract as much privatised profit as possible, rather than to make efficient use of money to help the people in care, I am not surprised that the pandemic response was so uncaring.

I think it sounds worse than it is. The number of oxygen machines is limited and the chances of survival even with an oxygen machine are not good for elderly people. If your projections say that you will get a certain number of younger people that will also need an oxygen machine then it makes sense to reserve those machines, they have a much higher chance of survival when using an oxygen machine.

Not doing a proper medical examination on the other hand is irresponsible imo.

You're overlooking the fact that Sweden's policies encouraged the spread of COVID. It wasn't inevitable that so many people got COVID before the vaccine.

I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.

"This is quite shocking. I didn't think this would be possible in a country like Sweden."

None of us living here thought it would be possible either. These irrational procedures, and the fact that the social democrats have repeatedly been stating in no unclear terms that Sweden's biggest problem is the elderly/geriatric demographic "who provide nothing and just cost us a lot of pension money", is why people think the strategy was entirely deliberate.

Would you have a cite for that? I would expect any politician admitting to that (as opposed to merely thinking it) to get crucified even in Sweden.

So they simply put their elderly population to sleep like a rabid animal and claimed it was effective strategy against COVID19 to not lock down.

Reply on news.ycombinator.com